How to Treat a Spinal Cord Injury

Essential steps to keep a patient safe and prevent further damage.

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Whenever someone has a head, neck, or back injury, you should suspect a spine injury. Whenever someone falls more than a few feet, even if he lands on his feet, you must suspect a spine injury. And if no one saw the accident and the victim is unconscious—or even the least bit disoriented—and there’s even a remote possibility that there could be a head or neck injury, you need to treat the victim as if he has sustained one.

In other words, assume guilt until innocence is proved. Unless you’re sure there was no spine injury, you must assume there was one. That means not moving the victim—not even allowing her to slightly move her head—until you have either (1) ruled out a spine injury or (2) stabilized the spine so it will not move.

The reason to be so careful is simple. If part of a fractured vertebra moves and presses on the spinal cord, this could result in paralysis.

Exceptions to the ‘No Moving the Patient’ Rule

If there’s immediate, impending danger—for instance, if the victim is in the direct path of a forest fire or an oncoming train or unstable overhead rocks—you might have to make a judgment call and skip the no-movement rule. Even then, try to pad the neck if you have time, and move the victim as carefully as possible. One way to do this is with a trap squeeze (see below).

Another judgment-call situation is when there’s serious bleeding, cardiac arrest, or another immediately life-threatening problem. It just makes sense to give priority to that before dealing with the spine. Even then, be as careful as you can.

How to Check For a Spine Injury

To check a spine properly, it helps to have some training. A hands-on course is best.

Defer to expert medical assistance if at all possible, but if none is coming and the victim is alert, oriented, and cooperative, with no other painful, distracting injuries, assess the spine by following the steps below. (If the victim isn’t alert, oriented, or cooperative or is distracted, skip this assessment and go to “Moving, Step 1” below)

Ask for permission: Consent is always a must before examining or treating anyone alert enough to reply.

Slip a cervical collar on the victim without moving his head: Use a commercially manufactured cervical collar if you have one, but if you don’t, improvise with whatever soft materials—such as cloths, pillows, and sleeping bags—you have on hand. Arrange enough of the padding around the victim’s neck to prevent his head from moving in any direction—including tilting up and down. Wrap or tape everything in place snugly but not so tightly that you risk choking the victim or impairing breathing in any way. If no padding is available, or there’s any possibility that the victim might move, have someone hold the head, or you can kneel and hold it between your knees. Bottom line: never move the head or body, even during the exam.

Press on each vertebra to check for tenderness: The vertebrae are those protrusions you can feel in your spine. Start at the upper neck and work down. If the victim is lying on his back, you may not be able to get to the thoracic (chest-level) vertebrae, so press on each rib instead. If a vertebra connected to a rib is injured, pressing on that rib will elicit pain.

Check the fingers and toes for sensation: Use a safety pin or your fingernail to lightly scratch one side, then the other, of both feet and hands (without breaking the skin). Ask the victim to tell you which hand or foot— and which side of it—you’re scratching. Check every toe and finger. Compare the sensation in one hand to the sensation in the other.

Check muscle strength: Ask the victim to flex his ankle by pointing his toes up toward the body. Give the top of the foot a little resistance with your hand. Next have him point his toes in the opposite direction, again with a little resistance from you. Have him grip a couple of your fingers and squeeze. Finally, have him spread all his fingers apart. Gently try to squeeze them together. For each test, compare sides to assess strength.

If you find tenderness along the spine, loss of sensation, or muscle weakness, assume there may be a spine injury. If you cannot rule out a spine injury, medical help becomes essential, even if you have to get it there by helicopter.

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Moving, Step 1: Prepare a Backboard

If you do have to move the victim, take a minute to assess the situation and make a plan. Try to gather some helpers—ideally, at least three. Then prepare a backboard.

If you have a commercial backboard, that’s best. Otherwise, find a stiff board as long as or longer than the victim. Perhaps take a door off its hinges, remove the legs from a table, or, for a short victim, use an ironing board. If nothing else, bind together long, sturdy poles, but remember this: the backboard must be strong, straight, and so sturdy that there’s no possibility of its breaking or bending even slightly. If there is, don’t use it. On the other hand, if you and others have to move the victim very far, the more the board weighs, the more difficult moving him will be.

Next, find seven long strips of cloth or pieces of rope, which you’ll use to tie the victim to the board. Place them under the board (see the illustration below for positioning). Make sure the strips are long enough to wrap around the victim and tie.

Slide the board next to the victim.

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Moving, Step 2: Prepare for the Logroll

Logrolling is the most universally accepted way to properly move someone onto a backboard. It’s also the best method for moving someone onto his side to help his breathing. The goal is to avoid twisting or flexing the spine at all—keeping it as straight as if the victim were a board.

The logrolling process should have a leader. Let’s assume it’s you. Before the roll, have everyone and everything ready.

Get yourself into position: Kneel above the victim’s head and keep it still. During the roll, you’ll be in charge of rolling the head at the same speed as the body, making sure the neck doesn’t rotate. If the victim is lying on his back, you may be able to kneel down and hold his head between your knees until you’re ready to do the roll. If you’re alone, you may have to hold the victim’s head and have him try to assist you with the move, but this is far from ideal.

Get the other helpers into position: Have your helpers kneel beside the victim’s body, which should be between them and the backboard. They’ll be reaching over to grab the side of the victim closer to the backboard, then rolling him toward them so the backboard can be scooted directly behind him. If there’s only you and one other person, that person should kneel with one hand on the victim’s opposite shoulder and one on his hip. If there’s a second helper, that person should kneel and have one hand on the victim’s hip and the other on his leg. A third helper should be responsible for the knees and for repositioning the board when needed.

Get the victim into position: There are two lines of thought about what to do at this point if the victim isn’t conveniently already lying in a perfectly straight line. You could keep the person in whatever position you’ve found him and perhaps position him more neutrally during the logroll or just after. Or, before the roll, you could go ahead and put the person in what’s called the neutral position: gently turn the head, shoulders, hips, and legs so they’re straight, parallel, and facing the same way. Either way, any movement of the spine is a risk, but somehow you have to roll the victim to get him onto the board.

Moving, Step 3: Perform the Logroll

As the leader, make sure everyone knows what to do before you start. Then:

Have everyone pull the victim on his side in unison on the count of three.

Have a helper slide the board as close as she can get it to the victim’s back.

Have everyone, on the count of three, logroll the body back onto the board.

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Moving, Step 4: Secure the Victim

Now you’ll secure the victim to the backboard. This is to make sure his spine doesn’t move during transport and he doesn’t fall off the board.

Have someone hold the victim’s head in place throughout this process.

Stabilize the back and neck. Stuff anything soft in every space, nook, and cranny around and under the back and neck, still without moving the spine. You might also put something under the knees so they can be flexed a little for comfort. Stuff everything in so tightly that nothing can possibly move when you pick the board up and start the transport. Firm foam is a good choice, or roll up towels, blankets, sleeping bags, or a tarp. Clothing is another option. Make sure nothing is impairing breathing.

Tie the victim securely to the board using the ropes or cloths that you previously placed underneath it. (If you see a place you think the rope might rub raw, place a little padding between the rope and the skin.) Start with the ties at the lower legs, thighs, and hips. Crisscross the two ropes at the upper chest. Each should go over one shoulder and under the opposite arm. Tie the head down last, around the chin and around the forehead.

Make sure the body is secure enough to stay still even if the board tilts a bit. Periodically check the chest, neck, and head to make sure nothing is impairing breathing.

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Optional Movement Manuever: Trap Squeeze

If you have no one to help you do the logroll, or if you need to quickly move a victim over a short distance to get him out of danger, you can squat at his head, grab the shoulder muscles on both sides of the neck (the trapezius muscles, or traps), squeeze the head with your arms to stabilize it, and pull the person. Try not to raise the head any more than you have to, and pull in a straight line so there’s no twisting. You can also pull a victim onto a backboard this way by placing the foot of the board at his head and pulling him onto it lengthwise.

How to Survive Any Crisis

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